Medicare Advantage VBID hospice model

Improving patient support and continuity during the transition to end-of-life care

Beginning Jan. 1, 2022, specific UnitedHealthcare Medicare Advantage plans in Alabama, Illinois, Oklahoma and Texas will manage patient hospice care through the Centers for Medicare & Medicaid Services (CMS) Value-Based Insurance Design (VBID) program.  

Through this pilot program, UnitedHealthcare will work with you and your patients to ease the transition from medical treatment to palliative and hospice care. Your patients can receive pre-hospice consultation, plus more timely access to the Medicare hospice benefit. And, they may be eligible to continue receiving some transitional curative care services.

Impacted plans

The designated Medicare Advantage and Dual Special Needs Plans (DSNP) below are in states and jurisdictions where UnitedHealthcare has been approved to offer this plan benefit in 2022. 

State Area Centers  for Medicare & Medicaid Services (CMS) contract
Alabama Statewide H0432-003-000, H0432-004-000, H2802-041-000, H6528-033-000, H0432-012-000, H0432-010-000, H0432-009-000, H2802-044-000, H0432-013-000
Illinois Chicago H8768-005-000, H8768-010-000
Oklahoma Statewide H3749-001-000, H3749-017-000, H3749-018-000, H3749-020-000, H8768-008-000, H8768-009-000, H8768-016-000, H8768-028-000, H5322-031-000, H8125-003-000
Texas Corpus Christi

For WellMed impacted plans, billing instructions, provider eligibility and other details, please reference https://www.wellmedhealthcare.com/hospicevbid/.

For this pilot program, the WellMed information takes precedence over UnitedHealthcare processes and guidelines – the information provided on uhcprovider.com/mahospice applies only to Alabama, Oklahoma and Illinois.

Member eligibility

Here’s how to check if a patient is currently enrolled in one of the designated plans:

  • UnitedHealthcare Provider Portal: You can verify eligibility and benefits and check plan enrollment. Simply click Sign In at the top of this page and sign in with your One Healthcare ID.
  • CMS HIPAA Eligibility Transaction System (HETS): Use the CMS HIPAA Eligibility Transaction System (HETS) to verify that they are enrolled in an approved plan

Hospice eligibility and billing

In network

Limited to hospice providers that are contracted (participating) with UnitedHealthcare for Medicare in the designated states.

Patients who elect hospice at an in-network provider may have the option to continue some short-term curative services after they elect hospice.

Out of network

Any hospice providers that are NOT contracted with UnitedHealthcare for Medicare will be considered out of network. Patients who are part of the plans listed above can still choose to elect hospice care at out-of-network hospice providers that are Medicare-certified. 

How to process notifications and claims

Referrals and prior authorizations are not required for members to receive hospice care.

Send all notices and claim submissions to both UnitedHealthcare and the CMS Medicare Administrative Contractor (MAC).

  • UnitedHealthcare is responsible for processing and paying claims
  • The MAC will process the claims for informational and operational purposes only

Hospice VBID background

CMS created the Value-Based Insurance Design (VBID) model for hospice care as part of its commitment to innovation. By creating a more coordinated transition into end-of-life care, we can create a better path for patients and their families to use hospice care in a way that best meets their needs. 

Under the VBID model and in states and jurisdictions where UnitedHealthcare has been approved to offer such benefits:

  • UnitedHealthcare will be responsible for coverage and payment of all hospice-related services for UnitedHealthcare Medicare Advantage members covered by Original Medicare
  • These members will remain enrolled in UnitedHealthcare Medicare Advantage while receiving hospice services

Hospice care navigation

Members can choose to have a pre-hospice consultation to help understand their in-network and out-of-network hospice options. To request a consultation, members should call the number on the back of their ID card.

Transitional concurrent care

To help ease the transition to hospice care, members who select a hospice in the UnitedHealthcare network may be eligible to continue a subset of short-term curative care services. As required by CMS, this is only available to members covered by one of the UnitedHealthcare designated VBID plans and elect hospice at an in-network provider. Transitional concurrent care services are not covered if a member chooses an out-of-network hospice provider.

If it is determined that Transitional Concurrent Care is appropriate for a member, in-network hospice providers must:

  • Receive approval from Envoy Care Advocates prior to the member receiving services by calling 833-753-2970.
  • Work with the member or member’s authorized representative to complete a Transitional Concurrent Care Addendum. The addendum outlines the services that a member will receive as they transition into hospice and the date treatment will discontinue.
  • The hospice provider is required to submit a Transitional Concurrent Care Addendum within 3 calendar days of approval of coverage and hospice admission via secure email to Envoy Care Advocates at tcc@envoycareadvocates.com.

For questions on transitional concurrent care, hospice providers can call 833-753-2970.

Resources:

Questions?

  • UnitedHealthcare Hospice VBID program: Call 952-931-4041 (general program questions)
  • UnitedHealthcare Provider Services: Call 877-842-3210, 7 a.m. to 5 p.m. CT, Monday through Friday (claim-related questions)